Health Equity in Employer Health Plans for Obesity

The buzzwords are flying. Diversity, equity, and inclusion is such a common theme that all you have to say is “DEI” and people will nod solemnly. The same goes for social determinants of health – SDOH. However, the Northeast Business Group on Health (NEBGH) has gone further to connect the two and identify some real gaps in the equity of employer health plans when it comes to diabetes and obesity.

These two chronic diseases often travel together. They lead to other chronic diseases. But perhaps most notably they disproportionately affect marginalized racial and ethnic populations. NEBGH lays out seven steps employers can take to reduce the inequity.

1. Connect DEI Efforts to Health

NEBGH suggests bringing together employer commitments to diversity, equity, and inclusion with efforts to design benefits for employee health and well-being. So employers should analyze disparities in health outcomes to see what are the gaps in benefit design that contribute to different outcomes for employees with the same benefits. They should ask themselves, for whose benefit are we designing our benefit plans? In short, NEBGH advises:

“Consider whose voices are at the table when decisions are made about healthcare benefits and programs. How have these voices shaped what you offer?”

2. Design Benefits That Support Best Practices in Diabetes and Obesity Care

Sad to say, a lot of effort has gone into “wellness” programs that do more to shift blame for health outcomes onto employees than to improve their health. Instead, employers should be looking at gaps in coverage for effective obesity and diabetes care. Especially for obesity, this is sadly lacking.

3. Elevate the Health and Benefits Literacy of Employees

Especially because of self-stigma, the knowledge, attitudes, and behaviors of employees related to obesity and diabetes can fall short of what they need. Many if not most people living with obesity blame themselves and think that they must fix it all by themselves through sheer willpower. Thus the gap between the reality of obesity as a chronic disease and common feelings of self-blame leads to poor health outcomes.

4. Address Financial Barriers to Care

High deductibles and out of pocket costs for obesity and diabetes care undermine equity in health outcomes for marginalized racial and ethnic populations. Because they are simply barriers to access and adherence.

5. Assure Access to Racially Sensitive Mental Health Support

Depression and anxiety are not uncommon in association with obesity and diabetes. Stress from exposure to racism can compound the problem. So culturally relevant mental health resources can help employees better manage health conditions like obesity and diabetes.

6. Hold Vendors Accountable for DEI

If the insurers and health plan administrators delivering benefits for employers have little commitment to diversity, equity, and inclusion, then inequities will filter in. For example, without diverse provider networks, equity in health outcomes will suffer.

7. Advocate and Invest

Employers are in a unique position to advocate and invest in strategies to overcome obesity and diabetes. Because the human capital of their organization will benefit, productivity and profitability will benefit, too.

NEBGH has laid out a compelling case and a roadmap. Employer health plans play a big role for better or for worse in health equity with respect to obesity and diabetes.

Click here for the report from NEBGH, here, here, and here for further perspective.

Workers, painting by Kuzma Petrov-Vodkin / WikiArt

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April 23, 2022